Depressive symptoms are more common among sexual minority youth than heterosexual youth at age 10, develop faster during adolescence, and continue into young adulthood (even if they start to decline from age 18).
This is according to “Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study”, an observational study that followed almost 5,000 young people from 10 to 21 years of age in the UK. Published in The Lancet Child & Adolescent Health, it was authored by Madeleine Irish, MSc; Francesca Solmi, PhD; Becky Mars, PhD; Michael King, PhD; Glyn Lewis, PhD; Rebecca M Pearson, PhD; et al.
Previous research found that annually, in the UK alone between 2001 and 2014, on average across 10- to 19-year-olds, around 37 per 10,000 girls and 12 per 10,000 boys were treated for self-harm.
The findings suggest that sexual minority youth and are four times more likely to report recent self-harm at ages 16 and 21 years than their heterosexual peers, and are at higher risk of depressive symptoms from as young as 10 years old.
“We’ve known for some time that sexual minority youth have worse mental health outcomes, and it’s quite concerning that we’ve found this trend starts as early as 10 years old, and worsens throughout adolescence,” said the study’s senior author, Lewis.
To make for a robust sample of LGBQ youth, all participants who were not exclusively heterosexual were grouped into the same ‘sexual minority’ category, including 625 people (13%) who had described themselves as homosexual, bisexual, mainly homosexual, mainly heterosexual, unsure or not attracted to either sex.
The participants responded to questions about depressive symptoms seven times from age 10 to 21, and at 16 and 21 were asked if they had attempted to hurt themselves in the past year.
Depressive symptoms increased throughout adolescence in both groups but the increase was greater for sexual minority youth, who already were more likely to report depressive symptoms from age 10. Self-harm was more common among non-heterosexuals at both 16 and 21.
At age 18 years, the LGBQ adolescents were twice as likely to fulfil the criteria for a clinical diagnosis of depression.
Mental health outcomes were worse for each of the sexual minority groups compared to heterosexuals.
The researchers said that there may be numerous factors likely involved here.
“As these differences emerge so early, we suspect that a sense of feeling different might affect mental health before children can even articulate that difference. As they progress through adolescence, a range of stressors could be involved, such as discrimination, stigmatization, feelings of loneliness, social isolation, shame or fear or rejection, including at home or at school,” said the study’s first author, Irish.
The findings suggest that clinicians who encounter young people, whether in primary or secondary care, sexual health services, the emergency department, or as school nurses, should be mindful about sexuality in considering the wider context for depressive symptoms or self-harm.
“Clinicians should use language and questions that reflect openness about sexuality, and not assume heterosexuality, and they should be aware that a young person who identifies as not exclusively heterosexual may have struggled with mental health problems from early in development,” said co-author Pitman.
The fact we found mental health disparities at such a young age suggests that early interventions may be useful to prevent and treat such mental health challenges, Lewis said.
“Despite changes to public perceptions and attitudes in recent years, gay, lesbian and bisexual youth remain at increased risk of long-term mental health problems – addressing this inequality should be a research, policy, clinical and public mental health priority,” Lewis ended.